I've just finished reading a market research report1 which suggests that we are seven or eight years into a major health care revolution. Since 1977 there have been substantial increases in the sales of self-care products and publications. Medical devices formerly available only to health professionals are now being actively marketed to laypeople. Services provided only in the hospital as recently as a year or two ago are now available at home. And there have been unprecedented changes in our health attitudes and behaviors.
The figures cited in the report include the following:
- Forty-seven percent of U.S. adults say they exercise three or more times per week, up 100% since 1961. Eighty-one percent of regular exercisers have taken up the activity within the last three to five years.
- From 1977 to 1982 sales of exercise bicycles increased by more than 400%. Seven percent of U.S. households now own one.
- From 1977 to 1980, running shoe sales increased by over 270%.
- From 1976 to 1982, warm-up suit sales increased by over 280%.
- From 1970 to 1980, consumption of whole milk fell by 53%, while consumption of lowfat milk products increased 83%.
- From 1970 to 1982, sales of decaffeinated coffee increased by 250%.
- From 1970 to 1982, sales of yogurt increased by 250%.
- From 1976 to 1980, sales of bottled water increased by 134%.
- From 1968 to 1981, the number of health food stores increased by 525%.
- From 1970 to 1982, the total circulation of health magazines increased by nearly 250%.
. From 1977 to 1981, sales of self-care books increased by more than 1100%.
- Within the past eight years, there has been a huge increase in the number of persons committed to a self-care lifestyle. Twenty-five to 30 percent of U.S. adults now say they are moderately committed to such a lifestyle. Three to five percent say they are strongly committed to selfcare. The authors predict that the numbers in both categories will continue to increase.
- Over 40% of visits to doctors were to obtain advice and information which could have been obtained in self-care books and articles. $25 billion worth of services now provided by health professionals could probably be replaced by self-care measures.
- Sales of medical software for home computers may well increase 200-fold by the end of this decade.
What does all this mean? These statistics reflect a major change in our understanding of health. These changes, combined with the movement away from fee-for-service and toward flat-fee health financing, are transforming our health care system.
The Old Health Care System. Under the old system, the central person was the physician. He (or occasionally she) stood at center stage, directing the efforts of all other medical personnel as well as those of the patient. The patient was seen as little more than the container for the disease, the raw material upon which the physician was to practice his art. The patient stood by in mute astonishment as the wonders of modern medicine were applied to his or her problem.
Under the old health care system, going to the doctor was a familiar ritual: your complaint was your ticket of admission. The doctor looked you over, probed and poked a little, asked a few questions, and ordered a few tests. Then out came the prescription pad and you received some medicine. In more serious cases, you were referred to a specialist or hospital. You weren't supposed to ask questions. There was only one commandment for the patient: obey your doctor's orders.
The New Health Care System. In the new health care system, the informed layperson is the primary provider of health care. Instead of passively waiting for illness to occur and then depending on out doctors to "fix" what ails us, we are increasingly detecting potential problem' early and taking steps to prevent them long before they become serious enough to require a doctor's care.
The new health care system considers self-care the primary form of health care. Professional care is seen as an adjunct And when professional consultation is necessary, health consumers are much more likely to ask questions, seek second opinions, find their own sources of information, and patronize a. variety of practitioners.
We now realize that most important health decisions are made by individuals families, and communities, not by doctors. The new health center is not the hospital or the clinic but the home. The center of health power is moving from the physician to the informed, health-active layperson.
Future editorials will discuss the characteristics of the new health care system. We welcome your comments.
I. The Health Strategy Group, "Helping' Ourselves to Health: The Self-Care and Personal Health Enhancement Market it the U.S.," 1983 (prepared for Rodale Press Inc. by The Health Strategy Group, 32 Spring Street, New York, NY 10013).